Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Consider referring a patient with dysentery for specialist gastrointestinal assessment if any of the following are present:
- Presence of blood and/or mucus in the stool, which may indicate a diagnosis other than simple gastroenteritis and warrants further investigation NICE CG84.
- Symptoms suggesting clinical dehydration or shock, or if the patient is at high risk of dehydration, as these require urgent assessment and possible secondary care involvement NICE CG84.
- Failure of diarrhoea to improve by day 7, or uncertainty about the diagnosis, prompting stool microbiological investigations and possible specialist referral NICE CG84.
- Signs or symptoms suggesting an alternative serious diagnosis, such as severe or localized abdominal pain, altered conscious state, or systemic signs like fever above 39°C in older children, which may require specialist input NICE CG84.
- In adults, presence of red flag symptoms such as signs and symptoms of cancer or inflammatory bowel disease markers should prompt referral to secondary care NICE CG61.
In summary, referral is indicated when dysentery is accompanied by red flag symptoms, systemic illness, failure to improve, or diagnostic uncertainty, to ensure appropriate specialist gastrointestinal assessment and management NICE CG84,NICE CG61.